Memorial Healthcare System won the 2014 Gage Award for population health.
When an uninsured patient shows up in the emergency department (ED) seeking care for a severe, chronic illness, an opportunity to provide more cost-effective, preventive care is already lost. In 2006, South Florida’s Memorial Healthcare System (MHS) counted millions of dollars in unreimbursed care and numerous avoidable ED visits and admissions logged by uninsured patients. In response, MHS created the Health Intervention with Targeted Services (HITS) Program, an outreach initiative that links patients with insurance programs or medical homes. Since its inception, HITS has touched the lives of more than 14,000 people and has saved millions of dollars in patient care.
Coverage improves health, saves money
In 2006, MHS had 840 avoidable inpatient hospital admissions totaling $22.9 million in charity care losses. And many of the uninsured would have been eligible for government-sponsored programs. “We also found out quickly that emergency department visits and inpatient hospitalizations could have been avoided if patients had been linked to a medical home,” says Tim Curtin, MBA, MSW, administrative director for community services at MHS.
MHS developed the HITS program with three objectives:
- improve the health status of the community by linking the uninsured and underinsured to a medical home
- maximize the use of community, state, and federal resources
- reduce uncompensated care costs and avoidable readmissions
Targeted outreach finds patients before they find the ED
To reach these goals, MHS had to find eligible patients before they showed up in the ED and connect them with coverage or a community-based medical home. First, the hospital worked to engage residents in high-risk neighborhoods and gain their trust. HITS staff were hired directly from these neighborhoods due to their knowledge of local sociocultural challenges and potential barriers to health care. They, in turn, partnered with neighborhood associations, faith-based organizations, schools, and nonprofit agencies, building relationships deep within the community. “[Hiring from within the community] was a very important aspect of the program’s success, as the [people] we hired were already trusted within their communities,” Curtin says.
Hitting the street, the HITS team used geographic information system mapping to target 15 neighborhoods with the highest rates of hospitalized, uninsured patients. Over a six-month period, the team approached these neighborhoods using the following strategies:
- weekly outreach using a pediatric and an adult mobile health center, each equipped with a physician and medical assistants
- door-to-door visits with residents to explain the importance of establishing a medical home
- monthly health fairs and health education workshops
- screenings for eligibility for government-sponsored programs or MHS community health centers
Staff also identified patients who had been hospitalized as a result of chronic health conditions, including diabetes, hypertension, and cardiovascular disease. They reached out to them via personal letter, phone, or in-home visit to help them complete applications for Medicaid or MHS community health centers.
Since its inception, HITS has made tremendous strides in connecting patients to coverage, medical homes, and disease management. Approximately half of its 6,910 participants have been enrolled in Medicaid, Florida’s Children’s Health Insurance Program, or an MHS community health center. Over a three-year study period, MHS saved $284,856 in the ED, about $2.8 million in inpatient costs, and roughly $4 million overall. “Many factors [contribute to the] reduced costs,” Curtin says, “including better disease management, more primary care visits resulting in less severe cases, and/or behavioral change. In short, the patient is healthier.”
For more information on Memorial Healthcare System’s Health Intervention with Targeted Services Program, please contact:
Timothy G. Curtin, MBA, MSW
Administrative Director, Community Services
Memorial Healthcare System